Safety 

The US Food and Drug Administration has approved products containing .5% to 5.0% coal tar for sale without a prescription. There has been concern over the years about the possible carcinogenic risk of continued application of coal tar, especially in the amounts used in controlled treatments like the Goeckerman Regimen. Multiple studies, however, have concluded that there is no significant increase in cancer risk when coal tar is used in prescribed therapy regimens.12 

How supplied, cost 

There are multiple over-the-counter products containing coal tar. All products are topical. Most products are shampoos or other soaps. Other products include salves and ointments. Some of these are allowed to contain up to 20% coal tar and are blended and diluted with isopropyl alcohol and combined with a neutral base such as petroleum jelly. Most products cost between $10 to $15 for a month’s supply. 

Summary

Considering the burden of psoriasis and its potential for disability, along with the increasing use and cost of biologic therapies, treatment with coal tar presents an intriguing, efficacious, and attractive alternative. For milder cases of psoriasis, such as those isolated to the scalp or other small body surface areas, treatment with any of the multiple nonprescriptive forms of coal tar is ideal.

References

  1. Paghdal KV, Schwartz RA. Topical tar: back to the future. J Am Acad Dermatol. 2009;61:294-302.
  2. Levell N, Peters T. Care and punishment: a history of coal tar and wood tar in dermatology. British Association of Dermatologists website. www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=1398. Accessed May 4, 2017.
  3. WHO model list of essential medicines. World Health Organization website. http://www.who.int/medicines/publications/essentialmedicines/en. Accessed May 4, 2017.
  4. About psoriasis: statistics. National Psoriasis Foundation website. http://www.psoriasis.org/netcommunity/learn_statistics. Accessed May X, 2017.
  5. Zeichner JA. Use of topical coal tar foam for the treatment of psoriasis in difficult-to-treat areas. J Clin Aesthet Dermatol. 2010;3:37-40.
  6. Coal tar. The Psoriasis and Psoriatic Arthritis Alliance website. http://www.papaa.org/psoriasis-treatments/coal-tar. Accessed May 4, 2017.
  7. Kondelková K, Vokurková D, Krejseka J, et al. The number of immunoregulatory T cells is increased in patients with psoriasis after Goeckerman therapy. Acta Medica (Hradec Kralove). 2012;55:91-95.
  8. Borska, L, Andrys, C, Krejsek, J, et al. Serum levels of the pro-inflammatory cytokine interleukin-12 and the anti-inflammatory cytokine interleukin-10 in patients with psoriasis treated by the Goeckerman regimen. Int J Dermatol. 2008;47:800-805.
  9. Gupta R, Debbaneh M, Butler D, et al The Goeckerman regimen for the treatment of moderate to severe psoriasis. J Vis Exp. 2013;(77):e50509.
  10. Fitzmaurice S, Bhutani T, Koo J. Goeckerman regimen for management of psoriasis refractory to biologic therapy: the University of California San Francisco experience. J Am Acad Dermatol. 2013;69:648-649.
  11. Thorns A, Edmonds P. Pruritis. In: Sykes N, Edmonds P, Wiles J, eds. Management of Advanced Disease. 4th ed. New York, NY: Oxford University Press;2004:206-213.
  12. Cosmetic Ingredient Review Expert Panel. Final safety assessment of Coal Tar as used in cosmetics. Int J Toxicol. 2008;27(Suppl 2):1-24. 

This article originally appeared on Clinical Advisor